Medical Emergencies & Pharmacology
Assessment first
Use OPQRST for the chief complaint and SAMPLE for history, plus a full set of vital signs, blood glucose, and a focused exam. Altered mental status is a differential, not a diagnosis: hypoglycemia, hypoxia, stroke, overdose, seizure, and head injury are the common mimics.
Time-critical syndromes
Stroke: use BE-FAST, document the last known well time, check glucose, and transport to a stroke center without delay; do not give aspirin if hemorrhage is possible. Anaphylaxis: epinephrine IM 0.3 mg (1:1,000) in an adult, 0.15 mg in a child, repeated every 5–15 minutes as needed; antihistamines and steroids are adjuncts, never first. Opioid overdose: naloxone titrated to adequate respirations, with ventilation support. Asthma/COPD: nebulized albuterol, ipratropium, and CPAP in selected patients.
Pharmacology essentials
Know the five rights, the indication, the dose, and the contraindication for every drug you carry. Nitroglycerin is contraindicated with hypotension, right ventricular infarction, or recent sildenafil/tadalafil use. Aspirin is avoided with true allergy or active GI bleeding. Dextrose 50% and glucagon both raise glucose; glucagon is for when IV access fails. Document dose, route, time, and response.
Trap: a patient with 'pinpoint pupils and slow respirations' often has a co-ingestant - naloxone reverses the opioid but not the benzodiazepine or the hypoxia.
Rule of thumb: check a glucose on every patient with altered mental status. It is fast, cheap, and changes management.